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Adesina IluyemiPhD CandidateCHMI, Univ of Portsmouth, UKMember, eMobility [email protected] #20
eHEALTH NETWORK FOR AFRICA: NEED FOR LOW-COST MOBILE/WIRELESS INFRASTRUCTURES
RESEARCH & DEVELOPMENT PROPOSAL
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Content
• Health Problems in Africa
• Definition and Policy drivers for eHealth in Africa through wireless technologies
• Introducing the concept of wireless i-DeHI in Africa
• Barriers to wireless i-DeHI in AfricA
• Opportunities for WWRF
• Research and Development proposal
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Health Problems in Africa
• Africa has a population of about ONE billion people- Up to 70% lives in isolated rural areas
- Half lives on half a dollar per day
- Poor telecom & transportation infrastructure• Lack of Infrastructure and Capacity Healthcare delivery• Brain Drain: International and Local (Rural vs. Urban)
• Africa has 10% of world population with 25% of global health burden but with only 3% of global health workforce
• Poverty & Financial constraints- HIV/AIDS accounted for 2.4 million deaths alone in 2002- 40% survive on less than $1 per day- Malaria related mortality is at 1 million deaths (mostly children) yearly
• Enormous economic cost on health systems- 10% of individual income- 50% of Africa’s population pays out of pocket- Human resources impact
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eHealth as a developmental tool
• eHealth is the use of information (data) and communication technologies for health processes (Health System) either locally and at a distance (WHO 2005).
• eHealth involves telemedicine, telehealth, telecare, health management information systems, health knowledge systems etc.
• Health System is information, data and communication intensive and requires more than SMS
- Health Workers as “Knowledge Workers”- Patients as citizens (Citizen-centric eHealth)- Health System as Data processing organization
• Wireless technologies plus eHealth = mHealth
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Policy for eHealth in Africa
• Africa Union/ New Partnership for Africa’s Development (NEPAD)
• NEPAD’s Action Plan Strategy on sector development
- Alignment between telecom and health sectors
- Calls for a continental-wide eHealth infrastructure based on
wireless telecom infrastructure
• NEPAD’s eHealth for:
- Communication system
- Integration of & access to vertical HISs
- Extending healthcare to isolated and rural communities and
populations
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• Global initiatives in favour of eHealth is being championed by The World Health Organisation (WHO) under the Global Observatory for eHealth (GOe) (WHA 58.18)
• The European Union has plans for eHealth in Africa
- Using wireless/mobile technologies
• International Telecommunication Union (ITU) since 1998 has commissioned eHealth projects in developing countries using mostly wireless technologies
- The ITU-D Q14 Working Group is focussed on eHealth strategy and
policy development with interest in mobile/wireless technologies
especially in developing countries
• All support Public-Private Partnerships (PPPs) for eHealth
Global Policy for eHealth
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• To provide access to distributed health knowledge and information to mostly rural health workers.
• Urgency is required to meet the MDGs targets and to reverse the poor health and developmental ratings
• Geographical barriers to access health service provision especially in Africa (rural areas).
• Connectivity ( wireless telecommunications) is becoming widely accessible and available even in rural communities
• But there are issues: Cost, telecom infrastructure, existing health problems etc
Why eHealth for Africa
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• Mobile devices are relatively cheaper that Fixed computers
• Consumes less power (Lack of electricity)
• They are portable, hence more secured?
• Wireless networks are relatively cheaper and faster to build relative to build than fixed networks. For example , the Nigerian case
• Mobile/ Wireless technologies provide the best opportunity for Africa to achieve the “ Africa interconnectivity objective and for building eHealth Infrastructure
Rationale for Wireless eHealth in Africa
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Wireless tools use for eHealth in Africa
•Wireless technologies use: GSM/GPRS/3G, WiFi, WiMAX, WLL (Fixed or Mobile CDMA), Broadband wireless, Satellite, VSAT (Mobility vs Universal Access)
•Mobile devices: PDAs, Smartphone, Cellular phones, Tablet PCs, Laptops, smart cards, memory sticks, USB keys, sensors.
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FMFI 2007
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Health Workers using mobile devices
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• Health Systems in Africa are operated through a District Health System (DHS)
- Hierarchical and pyramidal territorial enterprise
- A distributed and geographically dispersed Enterprise
- An information and process intensive Enterprise
- A central urban hospital linked to peripheral semi-urban/rural health
centres
- Has different cadres of Health (Knowledge) Workers with information
needs for patient care & enterprise management
• Integrated District eHealth Infrastructure (i-DeHI)- Built on Wireless Infrastructure- Including mobile/portable hardware, software & wireless networks
A Innovative Concept Proposal
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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i-DeHI Innovationi-DeHI as the basic unit for an Africa-wide eHealth
Infrastructure
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i-DeHI
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A District eHealth Network
Basic architecture for health care delivery in Africa
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A Cluster of District Wireless eHealth Network = Regional eHealth Network
Regional or National eHealth Infrastructure will require use of different devices
and wireless networks with implications for interoperability and integration
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Lessons from African Cases
• UHIN-GPRS:- still limited in bandwidth
- Early generation PDAs-Planning for Smartphones
• Solar Energy
• Cell-Life- GPRS/3G- Business model
- PDAs/Smartphones
• FMFI/MUTI Telehealth- Long distance WiFi- WAN&LAN, VSAT- expensive, policy barriers
- Considering 3G
- Desktop Laptops WiFi -CellPhones
- Solar Energy
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A District eHealth Network
A rural eHealth project in rural South Africa using low-cost Mesh Wi-Fi networks
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FM
FI 2007
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Barriers to Wireless eHealth in Africa
• Technological
• Telecommunication Infrastructure ( policy, high investment costs , availability)
• Power /Electrical Infrastructure
• Economic/Financial Infrastructure - Low-income
• Organizational/Management issues
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• Lessons from an Africa-wide eHealth Network
• Multilateral Initiative on Malaria Communication Network (MiMCom)
- A continental-wide eHealth Infrastructure with 12 National nodes
• Inter-national nodes mostly with VSATs
- VSATs chosen over fibre-optics at inception
• Intra-national communication with terrestrial wireless-WiFi, microwave link
• Devices-Laptops, PDAs, PCs
• Reveals different solutions for national nodes- depends on availability and costs of bandwidths
Barrier 1: Telecom/Technological Infrastructures
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MiMCom continent-wide eHealth Network in Africa
This depicts national nodes with different networks
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Lessons from African CasesMelanges of devices and networks: Need for Ambient Network
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FMFI 2007WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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• Issues
- Non-availability of Low-cost Broadband Access
- High costs of broadband access especially of satellite connectivity
access
• Possible solution ?
- Low-cost Broadband Wireless Infrastructure
- Introducing EU funded Digital World Foundation project on Low-cost
Technology initiative
- Bring this issue into global business and developmental agendas
Barrier 2: Financial Infrastructure
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• European Research Framework
– Framework Programme 7 (2007-2013) just started
– DigitalWorld FP7-216513 is an 18 month research project
• ICT-1-9.1 - International Cooperation (Africa and Latin America)
• Coordination and Support Action
• Started January 1, 2008
• Duration: 18 Months
Introducing DigitalWorld EU Project
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User-centric mHealth conceptual model
Web Applications
Technology
EHR DDS HMIS Teleme-dicine
Human & Organisational issues
IntegrationInteroperability
ConnectivityAccess
MobilityDevices: Mobile, Nomadic & Portable
Wireless Infrastructure
Location: Homes, Facility & Community Levels
Geography: Rural/Urban
USERS: HEALTH WORKERS/ PATIENTS
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mHealth Users’ Context
USERS: Health Workers/Patients
Geography
Rural/U
rban
Com
munity
Facility
Applications/C
ontents
Devices
Mobile/F
ixed
Wireless N
etworks
Ad-hoc/R
eal-time
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Users issues 1
• Technical
- Human Computer Interface (HCI)
- Open Source (Hardware & Software)
• Social
- Adoption issues (Development & Implementation)
- Culture
- Local Knowledge
- Language
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Users issues: software & interface design
• HCI- Screen size and design
(Adaptive)- Network Configuration-Thin &
Thick clients, remote & located synchronisation
• Software
- Palm OS
- Symbian
- Windows Mobile
- Google Android
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Users issues: Hardware 1
• Open Source design?• Multi-wireless connectivity• Power- Solar? (Global Green
Movement)• Memory (Stable and Labile)• Security• Structure- (Ruggedized)• Low-cost devices-• Simputer
- OLPC- Classmate,- EeePC
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Users issues: Hardware 2
• Device Morphology/Transition - mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?• Isomerism?
• Users’ opinion from Africa- Desktop Laptops WiFi -CellPhones
UMPCs
•Low-cost UMPCs for Health•OLPC case
• Device Morphology/Transition - mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?• Isomerism?
• Users’ opinion from Africa- Desktop Laptops WiFi -CellPhones
•Low-cost UMPCs for Health•OLPC case
• Device Morphology/Transition - mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?• Isomerism?
• Users’ opinion from Africa- Desktop Laptops WiFi -CellPhones
•Low-cost UMPCs for Health•OLPC case
UMPCs
• Device Morphology/Transition - mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?• Isomerism?
• Users’ opinion from Africa- Desktop Laptops WiFi -CellPhones
•Low-cost UMPCs for Health•OLPC case
UMPCs
• Device Morphology/Transition - mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?• Isomerism?
• Users’ opinion from Africa- Desktop Laptops WiFi -CellPhones
•Low-cost UMPCs for Health•OLPC case
UMPCs
• Device Morphology/Transition - mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?• Isomerism?
• Users’ opinion from Africa- Desktop Laptops WiFi -CellPhones
•Low-cost UMPCs for Health•OLPC case
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Users: Social issues
• Doctors in South Africa (Banderker et al 2005)
- Job relevance
- Usefulness
- Perceived User resources
- Device Characteristics
- Supports from Public National government & hospital administrators
- Patient influence
- Legal issues (Decision Support Systems, Drug directories)
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Organizational issues 1
Technology• Technology is not enough! • Positive economic benefits• Users led and focus• Social and ethical issues • Health workers’ responsibility• Device and applications development and regulation.
(HealthService 24- 2006)
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Organizational issues 2
Environment• Health Policies, regulation, structure and financing• Evaluation in real-life contexts• Multiple actors and structures• Health IT infrastructure (organisation).• Users’ Trust• Users’ led model
(MOSAIC -2005)
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• 70% of IT investments globally are failures: Note failure here is multifaceted
• Africa is not faring better either
• Same problem with eHealth projects especially in Africa
• Hence, problem is sustainability which can be:- Organisational /Environmental
- Social/cultural
- Human (Health Workers)
- Technological
Sustaining eHealth projects in Africa
80% cause of IT Failure
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• Building a sustainable Business Model for ‘Win-Win Situation’- Understanding and Meeting Multiple Stakeholders
- End-users needs for design: Pro Poor vs. Niche markets- Understanding Organizational Process for innovation diffusion
- Understanding Environmental Constraints and Enablers: Policies/Regulation, Electricity (Renewable Energy), Financial/Economic/Funding
- Instituting sustainable Global & Local Public-Private Partnerships (PPPs)- Supporting Local Small & Medium Enterprise (SMEs) - Supporting Low Access/Entry costs models
• Technological- Low cost Broadband Infrastructure- Wireless Telecom such as WiMax, WiFi, Broadband Satellite- Low cost mobiles devices and Laptops (OLPC, Intel Classmate etc- Open Source vs. Proprietary Software & Hardware?
Sustainability issues
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Sustainable Solutions
• High investment, implementation and purchasing costs of wireless telecom infrastructures as barriers (Gilhooly 2005, World Bank 2008)
• Policy needed to stimulate:- Public service innovation/re-engineering (eHealth)- Mass and low-cost production of components- Appropriate Business models- “Bottom of the Pyramid” (BOP) model- Local and Global Public-Private Partnerships (PPPs) (NEPAD e-Schools
project)- Social and developmental inputs in Telecom regulation & business
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• User-centric wireless products & services in developing countries
- Case studies demonstrate the feasibility of mHealth in Africa
Health System
- Low-cost portable and mobile devices like the OLPC are needed
- Low-cost broadband wireless infrastructure are also required
• Research to influence future design and development
• To support wireless eHealth business model in developing countries
- Being developed with Rural Living Labs Europe- To be instituted in four regions of Africa- To develop a sustainable wireless eHealth model
Opportunities for WWRF-WG 1
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Opportunities for WWRF-WG 2
• Transmission - Wireless Broadband for eHealth web services and applications
• Development of optimal/low-cost mobile/portable/nomadic devices, infrastructures and software
• Ambient Wireless Networks- Melanges of wireless networks- Need to explore interoperability for facility, community, district,
provincial, national regional and continental access and connectivity
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• Reviewing all eHealth projects in developing countries especially on mHealth
- Focus is specifically on the factors affecting eHealth sustainability or
success in Africa
- Operational & strategic management of eHealth implementation &
use in Africa
- Developing a holistic framework to evaluate existing eHealth
systems in Africa i.e. linking operational with strategic (policy) level
• Framework will capture process and outcome impacts from design to implementation and use
• Funding required for field trips to Africa
Ongoing Research Work @ CHMI
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• A call to WWRF to support research into:• Low-cost mobile/wireless technologies for Development in Africa
- eHealth - e-Education- e-Agriculture- e-Business, e-Commerce, e-Banking
• Scoping change management issues in using mobile/wireless technologies for eHealth in Africa / Developing countries
• THANK YOU FOR LISTENING!
Conclusion
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Dr Adesina IluyemiPhD CandidateCHMI, Univ of Portsmouth, UKMember, eMobility [email protected] #20
eHEALTH NETWORK FOR AFRICA: NEED FOR LOW-COST MOBILE/WIRELESS INFRASTRUCTURES
RESEARCH & DEVELOPMENT PROPOSAL